Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 15141 | WV |
Y | 207PE0004X | Emergency Medical Services | 15141 | WV |
NPI | 1053410936 |
---|---|
Provider Name | Debra L Henry |
First Address | Glen Dale, WV 26038-1660 |
Second Address | Glen Dale, WV 26038-1660 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 20/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0052585000 | (05) | WV |
F13402 | (02) |